Diaphragmatic palsy after cardiac surgery in adult and pediatric patients

Abstract

Background Important differences in the mechanism of respiration between adults and children warrant distinction in the management of diaphragmatic paralysis as a complication of cardiac surgery. We describe the management and outcomes of this complication in both groups. Methods We retrospectively analyzed 16 patients (5 adults and 11 children) with diaphragmatic paralysis after cardiac surgery performed between 2008 and 2018. Clinical examination, chest radiography, and confirmation with fluoroscopy in selected cases were our modalities of diagnosis. All adults were managed conservatively, whereas plication was performed in all children. Results The incidence of diaphragmatic paralysis was 0.98% in pediatric patients and 0.43% in adults. The mean age was 2.33 ± 2.59 years in children and 53.2 ± 17.99 years in adults. All adults were symptomatic. All children showed difficulty in weaning from mechanical ventilation after cardiac surgery. The period of mechanical ventilation before plication was 2–6 days (median 4 days). Death occurred as a result of low cardiac output in a 10-year-old boy, and due to respiratory failure in a 30-year-old woman. Children were successfully weaned from mechanical ventilation after diaphragmatic plication. The median time to extubation after plication was 2.5 days (range 1–13 days). The median period of recovery in adults was 52 days (range 32–85 days). All survivors had acceptable outcomes at 6 months to one year. Conclusion Conservative management in adults and early plication in children are viable treatment options for diaphragmatic palsy after cardiac surgery, with acceptable outcomes.

A Single Center Observational Study of Spirometry Assessments in Children with Congenital Heart Disease after Surgery

“…Other contributions to lung dysfunction include alterations of the chest wall's mechanics due to sternotomy, the presence of postoperative atelectasis, pulmonary edema or pleural effusion, and impaired respiratory efforts due to postoperative pain [20,21]. Phrenic nerve injury has also been reported to induce hemidiaphragmatic paresis or paralysis after the surgical correction of CHD, resulting in poor PFT [22][23][24].…”

Frequency and risk factors of Unplanned 30-day readmission after Open heart surgeries: A retrospective study in A tertiary-Care-Center.

“…Nevertheless, a retrospective cohort study in the United States between January 1, 2005, and November 30, 2007, showed that the 30-day readmission rate after cardiac surgery ranged from 8.3% to 21.1%, with the most common reasons for readmission being postoperative infection (16.9%) and heart failure (12.8%) (12) . Iribarne and colleagues in a prospective study reported that the overall rate of readmission was 18.7% with female gender, diabetes mellitus, COPD, elevated creatinine, and lower hemoglobin being the top most common risk factors for re-admission after cardiac surgery (13) . Additionally, a recent retrospective observational study done in Northern New England revealed that the 30-day readmission rate after cardiac surgery was 12.3% (14) .…”

“…Additionally, a recent retrospective observational study done in Northern New England revealed that the 30-day readmission rate after cardiac surgery was 12.3% (14) . Moreover, there is a variation of the most common type of cardiac surgery associated with readmission (13)(14)(15) . Lowering readmission rates is an important goal of all care providers for future quality improvement and cost contaiment.…”

“…This could be because of higher blood viscosity and decrease flow. Iribarne and colleagues found that high postoperative hemoglobin was a protective parameter for the risk of readmission (13) . Post-op Urea have a significant link with increased rates of readmission (p < 0.0001).…”

Clinical application of ultrasound in paediatric diaphragmatic dysfunction

“…Non-invasive ventilation is a preferred therapy to maintain respiratory function and allow the diaphragmatic function to recover [14]. Other conservative DD management mainly includes spirometry, chest physiotherapy, daily walking, taking frequent deep breaths and keeping a semi-sitting position [47]. One-year inspiratory muscle training after cardiac surgery can improve diaphragmatic mobility and the inspiratory muscle strength of children with DD [ 48 ] .…”